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Making China safe for Coke: how Coca-Cola shaped obesity science and policy in China

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Rapid responses are electronic letters to the editor. They enable our users to debate issues raised in articles published on thebmj.com. Although a selection of rapid responses will be included online and in print as readers' letters, their first appearance online means that they are published articles. If you need the url (web address) of an individual response, perhaps for citation purposes, simply click on the response headline and copy the url from the browser window. Letters are indexed in PubMed.

I'd like to thank Dr. Susan Greenhalgh for her work in exposing the role of Coca-Cola in China's public health efforts. I hope that other researchers will follow suit elsewhere.

Coca-Cola's influence, however, appears to exceed even what Dr. Greenhalgh has demonstrated here. This article claims that Chen Chunming “became the founding president of the Chinese Academy of Preventive Medicine, a division of the Ministry of Health that was the forerunner of the CDC, and in 1993 left to head up ILSI’s new ‘Focal Point in China’ (ILSI-China), which she headed until 2004.” While it is reasonable to expect that a public health official would leave her government position prior to—or at the very least after—founding an ILSI entity, that is not what happened. Rather, Chunming’s research published after 1993 confirms that she retained her position at the Academy of Preventive Medicine. As a sample, please see the following articles:
“Nutrition status of the Chinese people” (https://www.ncbi.nlm.nih.gov/pubmed/8886318)
“Eating Patterns: A Prognosis for China”
“Research Proposal: The Interaction of Health, Education and Employment in Western China” (https://drive.google.com/file/d/0B8wI0BJ2R7tMY1VzQkw0SURRZG5uQ1BNQ1l6QlF...)
“Awareness, treatment and control of hypertension in patients attending hospital clinics in China”
The latter article was published in 2003 and confirms that Chunming continued in her Chinese government position for a full decade after becoming the founding director of ILSI-China. In fact, when she received the Asia Pacific Clinical Nutrition Society Award shortly before her death in 2018, the citation still referred to her as “Senior Advisor on Science for the Chinese Center for Disease Control and Prevention” (http://apjcn.nhri.org.tw/server/APCNS/2018.pdf).

Moreover, Dr. Greenhalgh’s article somewhat misleadingly states, “The staff of the industry funded ILSI-China have unparalleled access to government officials, and the organisation established itself as a premiere scientific body capable of providing access to the best that Western science has to offer.” Yet, in at least two cases other than Chunming’s, ILSI-China's leadership simultaneously worked for the Chinese government as public health officials. ILSI-China's leadership does not require “access to government officials”; they are government officials. In the United States, pundits often complain of the “revolving door” between political and industry posts, and the conflicts of interest and regulatory capture this situation facilitates. Yet, to my knowledge, we do not have a term for the pattern of simultaneous industry and government employment that so often afflicts the field of public health. Perhaps we might refer to it as the double duty problem.

For example, a 2018 ILSI bio of ILSI-China director Junshi Chen states that he is "Chair of the Chinese National Expert Committee for Food Safety Risk Assessment and the Vice-Chair of the National Food Safety Standard Reviewing Committee." According to ILSI, Chen "has engaged in nutrition and food safety research for more than 50 years at" the Chinese CDC and its forerunner. The bio also states, “He has been Senior Research Professor at the China National Center for Food Safety Risk Assessment since 2011" (http://ilsisea-region.org/wp-content/uploads/sites/21/2018/04/Junshi-Che...).

My colleague Derek Fields and I first covered Chen and Zhao's overlapping ILSI-China and CDC roles in our January 2018 article "How America’s Soda Industry Conquered China’s Public Health Agency" (https://keepfitnesslegal.crossfit.com/2018/01/11/how-americas-soda-indus...). There, we observed,
“Despite all this advocacy for industry, Chen’s published papers in the Lancet declare ‘no competing interests ... Zhao’s published work declares ‘no conflicts of interest relevant to this article,’ despite her conflicted positions with EIM and ILSI ... In fact, in several instances Zhao listed her ILSI email as her official email address and still declared no conflicts of interest.”

And note that the articles where Chen and Zhao failed to acknowledge their ILSI conflicts of interest were published in outlets belonging to the United States CDC, as well as in the Lancet and JAMA, some of the most prestigious journals.

ILSI's extensive overlap with public health officials in South Africa, Malaysia, and the U.S. confirms that this phenomenon is not unique to China. Therefore, it is not appropriate to ascribe ILSI's role in China to China-specific factors such as the country's low funding of public health. Countries that generously fund health science and public health policies, such as the U.S., have tolerated similar inappropriate levels of industry capture. It would thus be naive to expect that an increase in the Chinese government’s public health funding alone would sufficiently address the ILSI problem. Instead, government policymakers and academic institutions must recognize the obvious truth about ILSI and its ilk. As we wrote in 2018, “If a corporation presents a conflict of interest, then a nonprofit it founded and/or funds presents a conflict as well." No one would accept a public health official simultaneously heading up a Coca-Cola branch. On what basis, then, is it acceptable for the same official to lead an ILSI outlet?

I salute Dr. Greenhalgh and the BMJ for helping to bring light to this issue and hope that JAMA, the Lancet, the U.S. CDC, and the Chinese CDC adjust their conflict-of-interest policies in accordance with the reality of industry-managed nonprofits.

Competing interests:
The author is a full-time employee of the fitness company CrossFit Inc., whose founder and chairman Greg Glassman has made it his company's goal "to drive Big Soda out of fitness and by extension, the health sciences."